Age / Sex : 55 / F

Chief complaint : Right dorsal foot pain for 2 month ago

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 이로운 (Ro-Woon, Lee), 인하대병원 (Inha University Hospital)

Mueller-Weiss syndrome

Discussion

Findings:

Plain radiograph image shows comma-shaped deformity due to collapse of the lateral part of the navicular bone and medial protrusion of the navicular bone

Bone scan image shows hot uptake on lateral portion of navicular bone and talonavicular joint.

MR image shows collapse of the lateral part of the navicular bone with subtle bone marrow edema at on T2FS image and enhancement at the corresponding part of the navicular bone and talonavicular joint surface on T1FS CE image.

Differential Diagnosis:

• None

Discussion:

• Spontaneous adult onset tarsal navicular osteonecrosis
  
  
  
  • Compression of navicular bone with talus and lateral cuneiform leading to spontaneous osteonecrosis of navicular bone
  
  
  
  


• Epidemiology: female > male, middle aged


• Cause : multifactoral, chronic loading uneven force on suboptimal ossified navicular -> lateral portion (most vulnerable area)


• Image finding
  
  
  
  • Gradual collapse -> fragmentation of lateral aspect of navicular
  
  
  • Lateral subluxation of talar head
  
  
  • Subtalar varus, pseudohindfoot valus, talocuneiform neoarticulation
  
  
  
  


• Treatment: conservative -> core decompression and bone graft, arthrodesis

References:

1. Mohammad Samim, Hicham A. Moukaddam, Edward Smitaman. Review. Imaging of Mueller-Weiss Syndrome: A Review of Clinical Presentations and Imaging Spectrum. AJR. 2016;207:W8-W18. 10.2214/AJR.15.15843